THE UNIVERSITY OF TEXAS AT EL PASO
PAYEE INFORMATION FORM
(Substitute W-9)
Individuals complete Part I & IV, Partnerships complete Part II & IV, Corporations or other Entities complete Part III & IV
I. INDIVIDUAL OR SOLE PROPRIETOR Name of Individual or Owner:
(Individuals/sole proprietors MUST provide a copy of social security card or photo id) "Doing Business As" (DBA) Name may be provided in Section IV below
A. I - Individual (not owning a business) Social Security Number (SSN) -- --
OR
S - Sole Proprietor of Business Social Security Number (SSN) -- --
(Sole Proprietors may also provide an EIN for tax reporting, if desired, see Taxpayer Name and Number on back)
Employer Identification Number (EIN) --
B. Citizenship Status: I attest under penalties of perjury, that I am (check one of the following):
1. A citizen or national of the United States
2. A Nonresident Alien (Complete C. below)
3. A Lawful Permanent Resident (Alien # )
C. Nonresident Alien Information - If you do not have an SSN, check here
Citizen of: Number of Days in the U.S.A. this calendar year:
Permanent Resident of: Number of Days in the U.S.A. in the past 12 months:
Payments to Nonresidents are generally subject to income tax withholding. Tax treaty exemptions may be available. Please visit the
Payroll Office located at Administration Building, Room 303, 500 W. University Avenue or call (915) 747-5171 for more information.
II. PARTNERSHIP Partnership's Employer Identification Number (EIN) - -
Enter two partner's names and Social Security Numbers (SSN). If either partner is a corporation, use the corporation's EIN.
Partner's Name SSN/EIN -- --
Partner's Name SSN/EIN -- --
III. CORPORATION OR OTHER ENTITY Employer Identification Number (EIN) - -
T - Texas Corporation A - Professional Association C - Professional Corporation L – Texas Limited Partnership
If T, A, C, or L is checked, enter Texas Charter Number
______
O - Out of State Corporation G - Governmental entity U - State agency / University
F - Financial Institution R - Foreign Business (outside the U. S. A. ) N - Other
IV. CERTIFICATION
NAME (for individuals)
or Business Name:
For payees Exempt From Backup Withholding enter "Exempt" below.
Address: Phone: (See Claiming Exemption under Backup Withholding on back)
(Number or street)
City: State: Zip:
Foreign Address:
(Enter city, province or state, postal code, and country)
Under penalties of perjury, I certify that the information provided on this form is, to the best of my knowledge, true, correct, and complete.
PAYEE SIGNATURE: ______DATE: ______
(Individuals and sole proprietors must also provide copy of Social Security Card or picture id)
Warning: Failure to provide the correct name and number combination may result in payment being subject to 31% backup withholding. See
Taxpayer Name and Number on back.
The University remits payments in accordance with the Texas Government Code, Chapter 2251, Texas Prompt Payment Act (PPA), which states that goods or services must
be paid within 30 days of the receipt of the goods or services or the receipt of the invoice, whichever is later.
Are you a state-certified Historically Underutilized Business (HUB)? Yes No If not, do you qualify? Yes No (see back for details)
Please send completed form to The University of Texas at El Paso, Purchasing & General Services, Kelly Hall, 3rd Floor,
500 W. University Avenue, El Paso, Texas 79968-0506 or send it via FAX to (915) 747-5932
UTEP is requesting disclosure of your SSN in order to report compensation to the Internal Revenue Service, as required by federal law. Further disclosure of your SSN will be governed by the Public Information Act (Chapter 552 of the Texas Government Code) and University policies.
Purpose of Form. – An organization that is required to file an information return with the IRS must obtain your correct Taxpayer Identification Number (TIN) to report income paid to you. The TIN is either the Social Security Number (SSN) or Employer Identification Number (EIN) of the payee. Nonresident alien information must be obtained to determine the payee’s tax status for compliance with IRS withholding and reporting requirements. The additional information for other payee types is needed to satisfy State of Texas requirements for establishing vendor records.Taxpayer Name and Number
Specific Instructions:
To prevent payments from being subject to backup withholding, you must provide a correct TIN. A TIN is considered incorrect if the name and TIN combination does not match or cannot be found on IRS or Social Security Administration (SSA) records.
Name. – If you are an individual, you must generally provide the name shown on your social security card. However, if you have changed your last name, for instance, due to marriage, without informing the Social Security Administration of the name change, please enter your first name, the last name shown on your social security card, and your new last name.
If you are sole proprietor, you must furnish your individual name and your SSN. You may also enter your business name or “doing business as” name on the business name line. The SSN will be used for your vendor record with UTEP. If you prefer the use of your EIN for any required tax reporting, enter that information also. Enter your name(s) as shown on your social security card and/or as it was used to apply for your EIN on Form SS-4.
What Name and Number to Give the Requestor
Type of Payee: / Name to use / SSN/EIN
1. Individual
2. Sole Proprietor
3. Partnership
4. Corporation
5. Other Entity / Individual
Owner
Partnership
Corporation
Organization / SSN
SSN or both
EIN
EIN
EIN
Nonresident Alien Individual
For income tax purposes, “nonresident alien individual” means an individual who is neither a U.S. citizen nor resident. Generally, an alien is considered to be a U.S. resident if:
· The individual was a lawful permanent resident of the United States at any time during the calendar year, that is, the alien held an immigrant visa (a “green card”), or
· The individual was physically present in the United States on: / (1) at least 31 days during the calendar year, and
(2) 183 days or more during the current year and the 2 preceding calendar years (counting all the days of physical presence in the current year, one-third the number of days of presence in the first preceding year, and only one-sixth of the number of days in the second preceding year).
See Pub. 519, U.S. Tax Guide for Aliens, for more information on resident and nonresident alien status.
Visa Status. – Immigration regulations regarding employment eligibility of nonimmigrants are complex. Contact The University Payroll Office for preliminary information regarding visa types that permit payment for services.
Withholding. – Foreign persons are not generally required to have a TIN, nor are they subject to any backup withholding because they do not furnish a TIN to a payer. However, non-employee payments to nonresident aliens are subject to 30% tax withholding unless a tax treaty with their country entitles them to either a lower rate or exemption. To claim any available treaty benefits, the recipient must have either a Social Security Number or IRS assigned TIN. In addition, IRS form 8233 must be filed with the payer.
Backup Withholding
What is Backup Withholding? – Persons making certain payments to you after 1992 are required to withhold and pay the IRS 31% of such payments under certain conditions. This is called “backup withholding.” Payments that could be subject to backup withholding include rents, royalties, non-employee compensation, and payments for medical and health care services. Reportable payments you receive will be subject to backup withholding if:
1. You do not furnish your TIN to the requestor, or
2. The IRS notifies the requestor that you furnished an incorrect TIN.
Payees and Payments Exempt From Backup Withholding – Certain payees and payments are exempt from backup withholding and information reporting. The following is a list of payees exempt from backup withholding and for which no information reporting is required. Payments subject to reporting under Internal Revenue Code (IRC) sections 6041 and 6041A are generally exempt from backup withholding only if made to payees described in items (1) through (7), except a corporation that provides medical and health care services or bills and collects payments for such services is not exempt from backup withholding or information reporting.
(1) A corporation. (2) An organization exempt from tax under section 501(a), or an IRA, or a custodial account under section 403(b)(7). (3) The United States or any of its agencies or instrumentalities. / (4) A state, the District of Columbia, a possession of the United States, or any of their political subdivisions or instrumentalities. (5) A foreign government or any of its political subdivisions, agencies, or instrumentalities. (6) An international organization or any of its agencies or instrumentalities. (7) A foreign central bank of issue.
Claiming exemption. – If you are exempt from backup withholding, you should complete this form to avoid possible erroneous backup withholding. Enter your correct TIN in the appropriate sections, and write “EXEMPT” in the block in Section IV.
Privacy Act Notice
IRC section 6109 requires you to furnish your correct TIN to persons who must file information returns with the IRS to report certain payments. The IRS uses the numbers for identification purposes and to help verify the accuracy of your tax return. You must provide your TIN whether or not you are required to file a tax return. Payers must generally withhold 31% of certain taxable payments to a payee who does not furnish a TIN to a payer. Certain penalties may also apply.
Penalties
Failure To Furnish TIN. – If you fail to furnish your correct TIN to a requestor, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect.
Civil Penalty for False Information With Respect to Withholding. – If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty.
Criminal Penalty for Falsifying Information. – Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment.
Misuse of TINs. – If the requestor discloses or uses TINs in violation of Federal law, the requestor may be subject to civil and criminal penalties.
Historically Underutilized Businesses (HUB)
The State of Texas is encouraging state agencies to utilize these businesses. You or your firm qualifies if 51% owned by a person or persons who have been historically underutilized because of their identification as a member of certain groups: Black Americans, Hispanic Americans, Asian-Pacific Americans, Native Americans, or Women-any ethnicity. To obtain a certification form, contact the U.T. El Paso Materials Management Office at (915) 747-7195.
With few exceptions, you are entitled on your request to be informed about the information UTEP collects about you. Under Sec 552.021 and 552.023 of the TX Govt Code, you are entitled to receive and review the information. Under Sec 559.004 of the TX Govt Code, you are entitled to have UTEP correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the UT System Business Procedures Memo 32. The information that UTEP collects will be retained and maintained as required by TX. Records retention laws (Sec 441.180 et seq. TX Govt Code) and rules. Different types of information are kept for different periods of time.